Yoshimoto M, Iwase T, Watanabe S, Kasumi F, Akiyama F, Sakamoto G
Surgical Department, Cancer Institute Hospital, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1992 Sep;93(9):1186-9.
Pathological investigations for intramammary spread of breast cancer of 205 partially resected specimens were performed by making continuous section every 5 mm width of the whole specimen. The materials were 167 quadrantectomized and 38 lumpectomized specimens. The results showed that the margin of 15.6% of quadrantectomized and 28.9% of lumpectomized specimens were positive for cancer, main causes of which were intraductal spread of cancer occupying 65% of positive margin in quadrantectomy and 91% in lumpectomy, multiple cancer, interstitial spread of cancer and so on. Multiple cancers were found in eleven (6.6%) quadrantectomized and in one (2.6%) lumpectomized specimens. Second cancers were 11 noninvasive ductal and 3 invasive cancers, including two triple cancers. Fifteen cases of quadrantectomy and 4 of lumpectomy were changed to be mastectomized because of positive margin or nodal involvements. Radiotherapy was performed for 33 cases. The median 31 months follow-up results of 186 partially mastectomized breast in 184 patients were as follows; one local recurrence in lumpectomy, two new cancers in residual breast, two distant metastases and one death for other cause of death. Quadrantectomy plus axillary dissection without radiotherapy assured of pathological complete resection was safe enough at the present.
对205例部分切除标本进行乳腺癌乳腺内扩散的病理学研究，方法是将整个标本以每5毫米宽度制作连续切片。材料包括167例象限切除标本和38例肿块切除标本。结果显示，15.6%的象限切除标本和28.9%的肿块切除标本切缘癌阳性，主要原因是癌的导管内扩散，在象限切除标本中占阳性切缘的65%，在肿块切除标本中占91%，还有多原发癌、癌的间质扩散等。在11例（6.6%）象限切除标本和1例（2.6%）肿块切除标本中发现多原发癌。第二原发癌为11例非浸润性导管癌和3例浸润性癌，包括2例三阴性癌。15例象限切除病例和4例肿块切除病例因切缘阳性或有淋巴结转移而改为乳房切除术。33例进行了放疗。对184例患者的186例部分乳房切除术后的中位31个月随访结果如下：肿块切除术后1例局部复发，残留乳腺出现2例新发癌，2例远处转移，1例因其他死因死亡。目前，象限切除加腋窝清扫且保证病理完全切除且不放疗是足够安全的。
